| INTRODUCTIONTraditional Chinese medicine in general and acupuncture in particular have been used for thousands of years in China. In the West, traditional Chinese medicine, especially that of acupuncture, has been known only recently. Anecdotal reports of patient improvement may be sufficient to persuade the health care consumer but failure to completely demonstrate the relationship of traditional Chinese medicine to known physiologic systems limits the acceptance of acupuncture in mainstream medicine. In recent years, functional magnetic resonance imaging (fMRI) has been generally accepted as strong tools for providing detailed information in the noninvasive mapping of brain function. For example, fMRI analysis clearly identifies the structures activated during thebrain's processing of pain, and the intensity of the response in regional cerebral blood flow correlates parametrically with perceived pain intensity. In addition, activations over disease-irrelevant brain sites have also been noted when acupuncture was applied to GB 37 or GB 34. Therefore, examining cerebral activation due to acupuncture stimulation may clarify the central mechanism of the therapeutic benefit of acupuncture.There are a lot of papers to discuss the mechanisms underlying the effects of acupuncture, but to the best of our knowledge, functional neuroimaging has not been previously applied to study the neuronal correlates of acupuncture over three acupoints (ST36, SP6, GB34) in different meridian channels respectively at the same volunteer. In this study, we compared the brain activation on fMRI among manual stimulation of ST36, SP6, GB34 and non-acupoint.SUBJECTS AND METHODSSixteen healthy volunteers (age 19-31 years; 13 males, 3 females), all right -handed, were enrolled. Only one volunteer had experienced acupuncture because of stomach pain before. All of the subjects were given the following instructions before the start of the fMRI experiments. They were informed thatdifferent models of manual acupuncture at various points in right thigh might be used for comparison. However, the precise locations of needling, the presumed acupuncture effects, and the stimulation paradigm were not divulged. During the experiment, the subjects were requested to keep their eyes closed and to use earplugs to reduce scanner noise. Adhesive strips were used to fix the forehead and thereby minimize head motion. Informed consent was obtained from each subject. The study was approved by authority of our hospital.MRI was performed on a 1.5T MR imager ( GE Medical System, Signa CV/i) with the following protocols: 1) T1-weighted spin echo axial images parallel to the anterior commissure-posterior commissure line from skull base to vortex; slice thickness=5mm, interslice gap=lmm, 22 slices; 2) blood oxygenation level-dependent (BOLD) functional images; the slice locations were identical to those of the T1WI structure images. 3) high-resolution structure images of the whole brain with a T1-weighted three-dimensional (3D) spoiled gradient recall echo sequence.A block design was adopted for the study. Each functional run lasted 5 minutes and 12 seconds, starting with 12 seconds baseline and five 30-seconds stimulation, the interval betweenthe two stimuli was 30 seconds. During the experiment, acupuncture needle manipulation was performed at ST36, SP6 and GB34 respectively in 14 subjects and non-acupoint in 2 subjects on the right leg. A 10 minutes interval was interposed between consecutive sessions. For each subject, before scanning started, the needle was inserted perpendicular to the skin surface to a depth of approximately 22mm.The data processing of the stimulation of ST36, SP6 and GB34 in 13 subjects (One subject who could not endure noise exited the experiment) was conducted with the software package AFNI:1) Motion correction. - The echo-planar imaging data were motion corrected by using a ratio-variance minimization algorithm (called "automatic image registration", or AIR). After motion correction, residual motion was reduced to less than 0.5 mm.2) Tala...
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